Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry

Jeanine Wakim El-Khoury, John E. Pandolfino, Peter J. Kahrilas, Bidemi Godo, Domenico A. Farina, Wenjun Kou, Dustin A. Carlson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The esophageal response to stepwise distension during the functional lumen imaging probe (FLIP) Panometry study often parallels high-resolution manometry (HRM) motility diagnoses. This study aimed to describe the changes in FLIP metrics during FLIP emptying, that is, reduced volume distension. Methods: Adult patients who completed FLIP and HRM for esophageal motility evaluation were included. Esophagogastric junction (EGJ) opening parameters were assessed during stepwise FLIP filling to volumes of 60 mL (“filling 60 mL”), then 70 mL, and then back to 60 mL (“emptying 60 mL”). HRM studies were analyzed per Chicago classification version 4.0 (CCv4.0). Key Results: Among 265 patients included, HRM/CCv4.0 diagnoses included achalasia in 80 patients (30%), normal motility in 70 (26%), and ineffective esophageal motility (IEM) in 43 (16%). EGJ-distensibility index (DI) and EGJ diameter were greater during emptying 60 mL than filling 60 mL in achalasia, normal motility, and IEM (p values <0.002). If applying the emptying 60 mL EGJ-DI (vs. filling 60 mL EGJ-DI), EGJ opening classification changed from reduced EGJ opening to borderline EGJ opening in 31% of achalasia patients and in 2% of patients with normal motility or IEM. EGJ opening classification was unchanged in 69% achalasia and 96% of normal motility/IEM. Conclusions and Inferences: This study suggests that isotonic or auxotonic relaxation of the lower esophageal sphincter occurs with reduced volume distension in patients with achalasia and normal motility. The study also supports the importance of utilizing a standardized FLIP motility study protocol (i.e., controlled, stepwise filling to 50 mL, 60 mL, then 70 mL) to provide reliable and generalizable FLIP metrics to facilitate diagnosis of esophageal motility disorders.

Original languageEnglish (US)
Article numbere14663
JournalNeurogastroenterology and Motility
Issue number11
StatePublished - Nov 2023


  • achalasia
  • esophageal motility disorders
  • impedance
  • manometry

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Gastroenterology
  • Physiology


Dive into the research topics of 'Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry'. Together they form a unique fingerprint.

Cite this